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National Cancer Institute®
Ultima Vez Modificado: 1 de febrero del 2002
UI - 11801498
AU - Zamir E; Mechoulam H; Micera A; Levi-Schaffer F; Pe'er J
TI - Inflamed juvenile conjunctival naevus: clinicopathological characterisation.
SO - Br J Ophthalmol 2002 Jan;86(1):28-30
AIM: Inflamed juvenile conjunctival naevi (IJCN) are often erroneously suspected to be malignant because of rapid growth. Their clinical and histopathological features have not been characterised in series of patients. The aim of the study is to characterise IJCN clinically and histopathologically. METHODS: This is a retrospective non-randomised clinicopathological study. All patients younger than 20 years with conjunctival naevi which were excised between 1990 and 2000 were included. The clinical signs of the affected patients and the histopathological findings of the excised lesions were characterised. RESULTS: A total of 63 conjunctival naevi were resected. 25% of the patients had simple compound conjunctival naevi and 75% had compound naevi with prominent inflammatory histological features (discrete lymphocyte aggregates, plasma cells, and eosinophils). Epithelial cysts and solid epithelial islands were common in the IJCN. The IJCN were all located at or near the limbus, and characterised by recurrent periods of congestion and growth. 75% of the IJCN patients with complete medical records had a history of allergic disease. Marked conjunctival papillary reaction was present in all of the patients, indicating a possible conjunctival allergy. CONCLUSIONS: IJCN is a unique entity, different from simple compound conjunctival naevus. Its association with allergic conjunctivitis is suggestive, and despite periods of alarmingly rapid growth, is histologically benign.
UI - 11801499
AU - Kemp EG; Harnett AN; Chatterjee S
TI - Preoperative topical and intraoperative local mitomycin C adjuvant therapy in the management of ocular surface neoplasias.
SO - Br J Ophthalmol 2002 Jan;86(1):31-4
AIMS: To demonstrate the efficacy of mitomycin C as adjuvant therapy preoperatively and intraoperatively in the management of recurrent or diffuse ocular surface neoplasias. METHODS: The case notes of 11 patients receiving mitomycin C adjuvant therapy as 0.04% eye drops four times a day in two weekly courses preoperatively and/or a single intraoperative application of 0.4 mg/ml of mitomycin C were reviewed. The histopathology included conjunctival primary acquired melanosis, conjunctival melanomas, sebaceous cell carcinomas with conjunctival intraepithelial spread, and conjunctival intraepithelial squamous neoplasias. Seven patients had additional limited local excision of the residual tumour mass and one had cryotherapy. RESULTS: All cases showed a favourable response to mitomycin C adjuvant therapy with regression in size or retardation of a rapid growth pattern and no serious sequelae. Postoperative follow up of 6-36 months following excision of the lesion with or without intraoperative mitomycin C showed no clinical recurrence in any of the cases. CONCLUSION: In this series, mitomycin C adjuvant therapy of recurrent or diffuse ocular surface neoplasias was well tolerated and showed favourable clinical results.
UI - 11825800
AU - Shields CL; Shields JA; Perez N; Singh AD; Cater J
TI - Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations.
SO - Ophthalmology 2002 Feb;109(2):225-34
AD - Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
OBJECTIVE: The objective of this report was to evaluate ocular and systemic outcomes after primary transpupillary thermotherapy for choroidal melanoma and to identify the limitations of this treatment method. DESIGN: Noncomparative interventional case series. PARTICIPANTS: The participants included 256 patients with newly diagnosed choroidal melanoma. MAIN OUTCOME MEASURES: The outcome measures included local tumor recurrence and visual acuity. RESULTS: Before treatment, the mean tumor base was 7.1 mm, and mean tumor thickness was 2.7 mm. Overlying subretinal fluid was present in 215 cases (84%) and orange pigment on the tumor surface in 200 cases (78%). All tumors showed either photographic documentation of growth (114 cases; 45%) or substantial risk factors for growth (142 cases; 55%). After a mean of three treatment sessions, complete tumor control without recurrence was found in 232 cases (91%) and recurrence in 24 cases (9%). The mean time to recurrence was 22 months, and the mean recurrent tumor size was 3.8 mm base and 2.4 mm thick. Of the recurrent tumors, additional thermotherapy was successful in controlling 13 (5%), plaque radiotherapy in 8 (3%), and enucleation in 3 (1%). Using multivariable analysis, the risk factors for tumor recurrence included increasing number of thermotherapy sessions (reflecting less responsive tumor) (P = 0.0001) and optic disc overhung by tumor (P = 0.03). Kaplan Meier estimates revealed that 4% showed recurrence at 1 year, 12% at 2 years, and 22% at 3 years follow-up. When analyzing those 214 patients without multivariable risk factors for recurrence, Kaplan Meier estimates for recurrence were 2% at 1 year, 8% at 2 years, and 10% at 3 years. The visual acuity after treatment was 20/20 to 20/40 in 128 cases (50%), 20/50 to 20/100 in 47 (18%), and 20/200 or worse in 81 (32%). Using multivariable analysis, the most statistically significant factors at initial visit that were predictive of poor visual acuity (20/200 or worse) after treatment included documented tumor growth before treatment (P = 0.0001), mushroom tumor configuration (P = 0.002), initial symptom of blurred vision (P = 0.008), poor initial visual acuity (P = 0.005), superior quadrant tumor location (P = 0.03), underlying diabetes mellitus (P = 0.04), and optic disc overhung by tumor (P = 0.04). Tumor-related mortality occurred in two patients (1%), one of whom showed complete tumor regression to thermotherapy and the other with diffuse choroidal melanoma and local tumor margin recurrence. CONCLUSIONS: Transpupillary thermotherapy is an effective treatment for certain small choroidal melanomas. Appropriate tumor selection is critical to successful treatment. Patients with tumors abutting or overhanging the optic disc or those requiring more than three sessions for tumor control are more likely to develop ultimate tumor recurrence. Transpupillary thermotherapy can cause damaging effects to the retina, leading to visual loss shortly after treatment.
UI - 11825801
AU - Bechrakis NE; Foerster MH; Bornfeld N
TI - Biopsy in indeterminate intraocular tumors.
SO - Ophthalmology 2002 Feb;109(2):235-42
AD - Department of Ophthalmology, Universitatsklinikum Benjamin Franklin, Freie Universitat Berlin, Berlin, Germany. email@example.com
OBJECTIVE: To describe an intraocular biopsy technique that allows accurate histopathologic diagnosis in cases of clinically unclassifiable uveal tumors. DESIGN: Retrospective noncomparative consecutive interventional case series. PARTICIPANTS/METHODS: Intraocular biopsies were performed by a vitreous cutter either by a two-port clear cornea approach in 11 patients with unclassifiable iris tumors or by a three-port pars plana vitrectomy in 23 patients with unclassifiable choroidal tumors. Specimens were formalin fixed and paraffin processed. Hematoxylin-eosin and periodic acid-Schiff stains were performed in all cases, with additional immunohistochemical stains using the alkaline phosphatase, antialkaline phosphatase method in cases that could not be conventionally classified. MAIN OUTCOME MEASURES: Clinical observation and histopathologic examination of intraocular biopsies. RESULTS: In 97% of cases (n = 33) a definite diagnosis could be established by the biopsy specimen. A melanoma could be diagnosed in 73% of cases (n = 8) of iris tumors and in 57% of cases (n = 13) of posterior intraocular tumors. Other diagnoses included nevus, metastasis, vasoproliferative tumor, hemorrhage, gliosis, and scleritis. Complications were encountered in four cases: a vitreous hemorrhage occurred twice, an inconclusive biopsy result, and an intraocular tumor spread occurred once, respectively. No increased tumor-related mortality was observed after a mean follow-up of 44 months. CONCLUSIONS: Intraocular biopsy by a vitreous cutter allows the histopathologic examination of formalin-fixed paraffin-embedded tumor tissue. This increases the diagnostic accuracy, avoiding the risk of extraocular tumor spread seen with transscleral biopsy techniques.
UI - 11812429
AU - Brantley MA Jr; Worley L; Harbour JW
TI - Altered expression of Rb and p53 in uveal melanomas following plaque radiotherapy.
SO - Am J Ophthalmol 2002 Feb;133(2):242-8
AD - Center for Ocular Oncology, Department of Ophthalmology and Visual Sciences and Division of Molecular Oncology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
PURPOSE: To examine the expression of proteins in the Rb and p53 tumor suppressor pathways in uveal melanomas following plaque radiotherapy. METHODS: Immunohistochemistry and cell culture studies. Immunohistochemistry for Rb, p16, cyclin D1, p53, HDM2, and Bcl-2 was performed on twelve eyes containing posterior uveal melanomas that were enucleated following plaque radiotherapy. Cell culture studies were performed in three cases. RESULTS: The irradiated eyes were enucleated for radiation complications (five cases), local tumor recurrence (three cases), and other reasons (four cases). On histopathologic examination, all cases showed evidence of tumor cell loss. However, residual tumor cells were present in all cases, including those that were clinically regressed. Residual cells from three of the clinically regressed cases were cultured and demonstrated minimal cell division, marked cell death, and extensive chromosomal damage. Strong p53 staining was observed in six cases (50%) and was significantly associated with recent radiotherapy (P = .04). Abnormal cytoplasmic staining for Rb was observed in four cases (33%). CONCLUSIONS: Plaque radiotherapy of uveal melanomas induces DNA damage, inhibits cell division, and promotes cell death. These changes may be due, at least in part, to induction of p53, which activates genes involved in both cell cycle arrest and apoptosis. Plaque radiotherapy can also cause alterations in the expression of Rb, but the significance of this finding will require further study.
UI - 11812446
AU - Shields JA; Eagle RC Jr; Shields CL; Nelson LB
TI - Progressive growth of an iris melanocytoma in a child.
SO - Am J Ophthalmol 2002 Feb;133(2):287-9
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. firstname.lastname@example.org
PURPOSE: To document progressive growth of a benign iris melanocytoma. METHODS: Interventional case report. A 9-year-old male underwent removal of a pigmented iris tumor that had been documented photographically to double in size. RESULTS: Histopathologic sections revealed a deeply pigmented mass with cytologic features typical of a melanocytoma. CONCLUSION: Although iris melanocytoma is generally a stationary lesion, it can show progressive growth. Such enlargement does not necessarily imply malignant transformation of the lesion.
UI - 11642372
AU - Garcia-Arumi J; Sararols L; Martinez V; Corcostegui B
TI - Vitreoretinal surgery and endoresection in high posterior choroidal melanomas.
SO - Retina 2001;21(5):445-52
AD - Hospital Vall d'Hebron, Universidad Autonoma de Barcelona, Spain. email@example.com
PURPOSE: Eyes with posterior choroidal melanomas more than 9 mm in thickness frequently are enucleated because of the potential complications of radiotherapy. The aim of this study was to evaluate the safety and efficacy of internal resection of these tumors. METHODS: Twenty-five consecutive patients with high posterior choroidal melanomas with a diameter less than 15 mm and a thickness greater than 9 mm were treated. If the retina was not invaded by the tumor, a vitrectomy was performed, followed by posterior hyaloid dissection, 120 degrees anterior retinotomy, endophotocoagulation 2 mm past the tumor margin, melanoma removal with the vitrectomy probe, retinal reattachment with liquid perfluorocarbon and air, and silicone oil exchange. If the tumor invaded the retina, the laser was applied through the retina, and the retina and tumor were removed together. RESULTS: The mean patient age was 46.6 years. The tumor thicknesses ranged from 9.1 to 12.8 mm, and the tumor diameter ranged from 8.9 to 14.8 mm. The mean preoperative visual acuity was 20/60. In 11 patients, the tumor had invaded the retina. We removed the entire tumor from all 25 eyes. The main postoperative complications were cataract (40%), retinal detachment (16%), macular traction (16%), and epiretinal macular proliferation (8%). The mean postoperative visual acuity was 20/100. No tumors recurred, and there was no evidence of metastasis. The follow-up ranged from 12 to 72 months. CONCLUSIONS: These data suggest that internal resection of high posterior melanomas may conserve ocular and functional vision and does not seem to increase the risk of metastatic disease. Longer follow-up is necessary to establish the safety of the procedure.
UI - 11642395
AU - Shields JA; Eagle RC Jr; Shields CL; Singh AD; Sarin LK
TI - Diffuse uveal melanoma presenting as an amelanotic cystic epibulbar lesion.
SO - Retina 2001;21(5):550-3
AD - Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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